Search

Hospital standardized mortality ratios published for the first time in Canada

New quality improvement tool designed to support efforts to reduce
in-hospital deaths
OTTAWA, Nov. 29 /CNW Telbec/ - For the first time in Canada, hospital
standardized mortality ratio (HSMR) results for eligible acute care hospitals
and health regions outside Quebec are being published today in a new report by
the Canadian Institute for Health Information (CIHI). The measure compares the
actual number of deaths in a hospital or region with the average Canadian
experience, after adjusting for several factors that may affect in-hospital
mortality rates, such as the age, sex, diagnoses and admission status of
patients.
"Hospitals and health care providers are continuously looking for ways to
improve quality of care for their patients," says Graham W. S. Scott, Chair of
the Board of Directors of CIHI. "The HSMR builds on this good work by
providing another important tool to better understand in-hospital mortality
and identify areas for improvement."
First used in the United Kingdom, the HSMR measure was adapted by CIHI
for use in Canada at the request of hospitals and patient safety experts. The
HSMR: A New Approach for Measuring Hospital Mortality Trends in Canada report
includes HSMR results for 85 larger acute care facilities/corporations and
42 health regions outside Quebec over the last three fiscal years (2004-2005
to 2006-2007). During this period, just over 254,000 patients died in Canadian
hospitals outside of Quebec. (Quebec results are not available due to
historical differences in hospital data collection.)
Today's report builds on earlier efforts to develop information about
quality of care and patient safety in Canada. A landmark study in 2004 funded
by CIHI and the Canadian Institutes of Health Research found that 7.5% of
adult medical or surgical patients had adverse events in hospital, about
one-third of which were deemed preventable by expert reviewers. Most patients
recover within six months, but each year, between 9,250 and 23,750 Canadian
adults experience a "preventable" adverse event in hospital and later die,
according to the study led by Ross Baker and Peter Norton.
"The HSMR is one tool for measuring and monitoring progress in patient
safety. It's a tool that can motivate change and make health care safer," says
Dr. Michael Baker, Physician-in-Chief at Toronto's University Health Network.
"HSMR numbers can be used as one measure of the quality of care, but the ratio
is best used as an indicator of trends, not as a target."
In-hospital mortality rates vary by patient group
The overall average HSMR fell by 6% over the study period (excludes
patients identified by hospitals as having received palliative care), but
trends vary by patient group. For example, death rates for patients with heart
attacks fell faster than those for patients with pneumonia. The HSMR measure
focuses on 65 diagnosis groups that account for 80% of in-hospital deaths,
excluding palliative care. The five diagnoses that had the highest numbers of
deaths were heart attack, heart failure, pneumonia, chronic obstructive
pulmonary disease and septicemia.
Age, sex and other factors related to risk of in-hospital mortality
CIHI's analysis found that older patients, those with certain health
problems in addition to their main diagnosis (such as kidney disease or AIDS),
urgent/emergent admissions and men had higher odds of dying than other
patients. These factors, plus the patients' length of stay in hospital and
whether or not they were transferred between hospitals, were taken into
account in calculating hospital and regional HSMR results.
"Some hospital patients are older or have more health problems than
others," says Glenda Yeates, CIHI's President and CEO. "The HSMR calculation
adjusts for these and other variables wherever possible, but each hospital and
community is unique. No measure can take into account all possible factors
that may influence the risk of dying in hospital, and as a result, HSMR
results are most helpful when used by individual hospitals and health regions
to track their progress over time."
HSMR: from measurement to action in Canada and abroad
Hospitals in the U.K. and the United States have been using HSMR results
to track in-hospital mortality and target areas for improvement in the
delivery of care for several years. For example, the Bradford Teaching
Hospitals Trust in the U.K. reported on its experiences in the Journal of the
Royal Society of Medicine last year. Its HSMR fell from 95 to 78 over four
years, an improvement that the hospital estimates translates into 905 fewer
deaths. Work with HSMR is also under way in several other countries, such as
the Netherlands and Sweden.
In Canada, hospitals and regions have begun to track their HSMR results
as part of efforts to improve care. For example:
- The Saskatoon Health Region has committed to transforming the care and
service experience in the region, including reduced hospital mortality.
In support of this goal, the Region is introducing rapid response teams
to prevent deaths in patients who are failing outside of intensive care
settings, and adopting practices to prevent ventilator-associated
pneumonia, to reduce medication problems and infections and to
standardize wound and skin care. The Region considers this work a key
plank in its efforts to improve patient safety.
- Pneumonitis due to inhaling solids and liquids is on the top-20 list of
diagnoses related to in-hospital death. Because of data it was able to
obtain from the HSMR, New Brunswick is able to focus on opportunities
to improve feeding practices for patients with dementia who have
trouble swallowing.
"In recent years, many hospitals, health regions and clinical teams have
implemented strategies to reduce the harm and deaths related to adverse
events, such as infections and medication incidents, and to improve quality of
care overall," says Phil Hassen, CEO of the Canadian Patient Safety Institute
and Chair of the Safer Healthcare Now! campaign. "It's promising to see that
these efforts are paying off, and to be able to measure this progress in a
tangible way."
About CIHI
The Canadian Institute for Health Information (CIHI) collects and
analyzes information on health and health care in Canada and makes it publicly
available. Canada's federal, provincial and territorial governments created
CIHI as a not-for-profit, independent organization dedicated to forging a
common approach to Canadian health information. CIHI's goal: to provide
timely, accurate and comparable information. CIHI's data and reports inform
health policies, support the effective delivery of health services and raise
awareness among Canadians of the factors that contribute to good health.